Employees Start to Feel the Squeeze of High-Deductible Health Plans • Hacker News Board

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#361

Post by hkai » Sat, May 04, 2019, 10:09 AM UTC

ericpauley wrote: post #239

pdonis wrote: post #230

Earlier quoted context omitted.

> Healthcare is best managed as a risk pool. No, health insurance is best managed as a risk pool, which, as you say, should obviously be everyone. But much of health care is not health insurance because it doesn't deal with insurable risks. Your need to get an annual physical isn't an insurable risk. Neither is a one-time appointment with a doctor to see if your headache and runny nose is just a cold or an infection…

While this may make sense from the perspective of why people get insurance (to mitigate a catastrophic loss), it doesn't consider the insurer's incentives. No insurance company will want to underwrite a plan that doesn't bundle routine services, since those clearly reduce risk of complications down the road. A yearly checkup is cheap compared to missing a disease and letting it get worse.

Is it? Here in Hong Kong, a health checkup once a year for 10 years will cost 5000 USD, which is also comparable with the cost of treating a moderately serious disease. Checkups are very expensive, and are not even remotely guaranteed to find some critical diseases.

So I would suggest that prevention is not necessarily cheaper than the cure for insurance companies, and largely their health programs like free checkups or fitness coupons are just marketing.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#362

Post by ZeroGravitas » Sat, May 04, 2019, 11:23 AM UTC

pdonis wrote: post #248

ericpauley wrote: post #239

Earlier quoted context omitted.

While this may make sense from the perspective of why people get insurance (to mitigate a catastrophic loss), it doesn't consider the insurer's incentives. No insurance company will want to underwrite a plan that doesn't bundle routine services, since those clearly reduce risk of complications down the road. A yearly checkup is cheap compared to missing a disease and letting it get worse.

> No insurance company will want to underwrite a plan that doesn't bundle routine services, since those clearly reduce risk of complications down the road But current plans don't require you to get routine services like an annual physical; they just cover them if you get them. That doesn't make sense if the insurer's incentives that you describe are driving the plan. Also, these incentives don't seem to be operating…

Most car insurance will cover, but not require, getting window chips fixed before the whole window goes.

They also give discounts based on security measures that reduce the chance of theft.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#363

Post by mikeash » Sat, May 04, 2019, 2:16 PM UTC

Domenic_S wrote: post #357

mikeash wrote: post #268

Earlier quoted context omitted.

They’re describing health insurance, except for the part where you pay what you can and get what you need and people are all in one pool.

We probably have different ideas of "paying what you can". How do you judge whether someone is only paying what they can, or they are taking advantage? Not a rhetorical question. One way is like we do today -- highly-paid positions often come with high-quality insurance, which is (ime) fairly expensive and low-paid positions have less expensive insurance that is a bit worse (all this on average, I'm sure there are ou…

There are cases where it’s hard to tell if someone is truly paying what they can, but there are also cases where it’s easy: when it costs more than they can pay. Health insurance trivially fails the “paying what you can” criterion for sufficiently poor people.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#364

Post by SlowRobotAhead » Sat, May 04, 2019, 3:49 PM UTC

jogjayr wrote: post #356

SlowRobotAhead wrote: post #215

Earlier quoted context omitted.

You can get an individual 401K or IRA and make all your own choices. If you're talking about an employer matched 401K, I don't think it's unreasonable at all for them to select it.

> If you're talking about an employer matched 401K, I don't think it's unreasonable at all for them to select it. What's special about 401k matching that requires the employer to choose plans? My employer doesn't force me to have a checking account with a particular bank they chose if I want to receive my salary. They should be able to match contributions to any account anywhere.

I don’t know if you understand how 401K matching works on the backend.

A lot of times the employers are capped on their own plans at a percentage rate that matches their employee’s participating. So matching is often in their best interest, esp at smaller companies.

But, easier version is this is a perk, not your base salary. They are paying you with legal tender and there are freedoms associated to that. There is no such thing for perks.

You aren’t entitled to make the administration choices for something they are gifting you.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#365

Post by jason_slack » Sat, May 04, 2019, 4:10 PM UTC

I currently have a high deductible health care plan because it is all that is offered by my wife's employer. The deductible is $4,500 per year.

If we just have normal well checkups, normal dental cleanings, normal eye glasses, and a few recurring prescriptions we would never hit the $4,500 deductible.

It is insane going to the pharmacy and having them tell you that the cost is $180 per month and have no choice but to pay it.

I went for a normal diabetes check and the lab work was over $600. No choice but to pay it.

I needed new glasses and no choice but to pay the $150 eye exam and then many hundreds of dollars for new frames and lenses (and I had no choice to get new frames or be without my glasses completely for 1-2 weeks).

To make it worse, we don't have any other choice of plan.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#366

Post by pg_bot » Sat, May 04, 2019, 5:32 PM UTC

tptacek wrote: post #345

pg_bot wrote: post #339

Earlier quoted context omitted.

I wouldn't expect it to be clear unless you've studied the area for awhile but all of those are external shocks to the marketplace. Healthcare expenses increase during wartime since you have to treat newly injured veterans. That statement basically can be interpreted as "people get injured on battlefields and it costs money to treat them".

First, once again: we have a nationalized health care system for injured veterans. They not only have a separate payer system but also a separate provider system. Second: I have followed health policy for quite awhile, and it's not clear to me at all what impact you believe your parenthetical callouts had on health costs.

First: I know you're not stupid so I have no idea what you aren't understanding when it comes to veteran care costs increase during wartime. Of course they have a separate payer and provider system. That system is included in the growth rate statistics. It should be fairly obvious that people being regularly shot at have higher healthcare costs.

Bankruptcy Law: In 2005 there were 2,000,000 bankruptcy filings, in 2006 there were 600,000. This was a result of the passing of the BAPCPA in 2005. At that point in time 46% of bankruptcies were due to medical bills. This change increased the expected value of delinquent accounts which in turn should lead to lower costs for medical services.

Great Recession: People put off non-essential medical expenses, or delay usage of medical services. Someone who might get braces doesn't, someone might take care of a parent themselves instead of hiring an in-home nurse, etc.

ACA Signed: Marker for before and after growth rates.

ACA Taxes + Exchanges Open: The two main policies of the ACA intended to curb healthcare costs go into effect. I would classify these two years as overestimation of savings and regression to the mean. Most insurance companies had to backtrack after their financial projections did not materialize.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#367

Post by jogjayr » Sat, May 04, 2019, 6:04 PM UTC

SlowRobotAhead wrote: post #364

jogjayr wrote: post #356

Earlier quoted context omitted.

> If you're talking about an employer matched 401K, I don't think it's unreasonable at all for them to select it. What's special about 401k matching that requires the employer to choose plans? My employer doesn't force me to have a checking account with a particular bank they chose if I want to receive my salary. They should be able to match contributions to any account anywhere.

I don’t know if you understand how 401K matching works on the backend. A lot of times the employers are capped on their own plans at a percentage rate that matches their employee’s participating. So matching is often in their best interest, esp at smaller companies. But, easier version is this is a perk, not your base salary. They are paying you with legal tender and there are freedoms associated to that. There is no…

> I don’t know if you understand how 401K matching works on the backend. A lot of times the employers are capped on their own plans at a percentage rate that matches their employee’s participating.

I actually do not understand this. Could you please explain more? What does an employer being "capped on their own plans" mean?

> But, easier version is this is a perk, not your base salary

When I make a decision on a job offer, the 401k match, health insurance premium, free lunch and snacks etc. all factor in and they're all worth a certain amount of money. Money is money and how it's labeled, "perk" or "base", is irrelevant. If my employer ends 401k matching, I'll treat it as a pay cut mentally.

My ultimate "fantasy" is to eliminate 401k altogether and instead let everyone contribute whatever the 401k annual limit is to an IRA. The employer can simply add matching funds to your IRA and you're free to have your retirement accounts anywhere you please.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#368

Post by tptacek » Sat, May 04, 2019, 9:27 PM UTC

pg_bot wrote: post #366

tptacek wrote: post #345

Earlier quoted context omitted.

First, once again: we have a nationalized health care system for injured veterans. They not only have a separate payer system but also a separate provider system. Second: I have followed health policy for quite awhile, and it's not clear to me at all what impact you believe your parenthetical callouts had on health costs.

First: I know you're not stupid so I have no idea what you aren't understanding when it comes to veteran care costs increase during wartime. Of course they have a separate payer and provider system. That system is included in the growth rate statistics. It should be fairly obvious that people being regularly shot at have higher healthcare costs. Bankruptcy Law: In 2005 there were 2,000,000 bankruptcy filings, in 2006…

No, I do not believe veteran health care is included in the statistics you are citing, and I am similarly dubious of your explanations for how each of those other 4 events impacted health care costs, because everything I've read suggests that the impacts are way more complicated than they look (for instance, much of the health cost impact from the "Great Recession" wasn't felt until years after).

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#369

Post by refurb » Sat, May 04, 2019, 11:19 PM UTC

tptacek wrote: post #346

refurb wrote: post #344

Earlier quoted context omitted.

I think we’re arguing different things. Sure, costs went up less after ACA. However, the ACA directly added costs to insurance that weren’t there previously.

I don't understand this argument. The ACA changed a bunch of things about the health care system. It reduced some costs and increased others. The point is to reduce the total cost (or, in this case, the total rate of increase in health care costs).

It reduced some costs

What were those?

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#370

Post by tptacek » Sat, May 04, 2019, 11:46 PM UTC

refurb wrote: post #369

tptacek wrote: post #346

Earlier quoted context omitted.

I don't understand this argument. The ACA changed a bunch of things about the health care system. It reduced some costs and increased others. The point is to reduce the total cost (or, in this case, the total rate of increase in health care costs).

It reduced some costs What were those?

P4P, bundled care, reference pricing, the IPAB-based spending controls, reduced hospital readmissions, the premium rate review process.

Can you help me understand the argument you were trying to make above? I continue not to grok the point you were trying to make.